<p>The CommuniCare Family of Companies is currently hiring for an ADR Billing Specialist.</p> <p>Requirements:</p> <ul> <li>Have an understanding of Medicare, Managed Care and Medicaid. </li><li>Background in Long Term Care billing processes </li><li>Preferred background in Medicare, Managed Care and Medicaid billing </li><li>Preferred knowledge of Point Click Care, Quadax and PrimeClaims </li><li>Understanding of ADR and appeals processes and workflows </li><li>Understanding of collections processes </li><li>Strong communication skills </li></ul> <p>Job Duties:</p> <ul> <li>Reviewing cases for Part B therapy appeals </li><li>Logging therapy appeal cases in Axis </li><li>Submitting therapy appeals to the appropriate payer via their web portals (IE: Availity, Buckeye, Caresource, etc.) </li><li>Submitting corrected claims to various Managed Care payers for missing authorization </li><li>Following up on appeals with auditing contractors and payers </li><li>Submitting write offs on accounts deemed uncollectible </li><li>Notating on accounts in PCC in compliance with the dashboard collection policy </li><li>Account research as it pertains to cash postings and adjustments </li><li>Monitoring the ADR payers </li><li>Ensuring proper logging and statusing of all ADRs and therapy appeals in Axis </li><li>Assisting with report set up to ensure accuracy of data </li><li>Set up for electronic eMDR notification in NPPES/Waystar for Medicare pre and post pay ADRs </li><li>Assisting with electronic notification set up for other various ADRs </li><li>Calculating at risk amounts for partially favorable ADRs required knowledge of updating/changing PDPM/RUG scores in PCC to obtain difference, and knowing what dates of service to change, and appropriately changing back </li><li>Other duties as assigned </li></ul>